Rather than try to predict the future, I would just like to say what I would like most in the future. And what I would like is for everyone involved to be clear that there are two quite different things both called therapy – the term I use to encompass psychotherapy, therapeutic counselling, counselling psychology, etc.
Adjustment therapy is dedicated to cure. The client comes in for the removal of symptoms which may be intensely painful or even disabling. Much crisis work is like this. In any case there is usually a pretty clear focus for the work, and one might call it focused therapy. It is relatively easy for therapist and client to agree on what is wrong and how to go about getting it right again. We are talking about restoration to normality. Most therapists have to do some of this work, and counsellors in particular are often faced with the need to do it, because they are often in front-line positions. In all situations where there is an external constraint on the number of sessions allowed, we have to speak of this form of therapy.
Liberation Therapy is dedicated to emancipation. The client comes in either with similar symptoms (but soon reveals that more is involved), or more commonly with much vaguer complaints. Phrases like – “My life is not working”, or “I just can’t make sense of it all”, or “I should be happy but I’m not” – indicate that there is no specific symptom to aim at. Such people are more in need of personal growth than of any kind of cure. The task here is to open up the way for the client to move on to the next stage in their psychospiritual development. We could call this unfocused therapy.
If this simple division were only better understood, many of the current arguments would be cut short. The demands of insurance companies, EAP employers, NHS trusts and accountants in general for specific results would be seen to apply only to Adjustment Therapy. In Liberation Therapy there are no specific results, because there is no clear aim. In fact, the very same move from “Esteem from others” to “Esteem from self (for example) could mean (for one client) becoming more involved with others, more compassionate, more loving or (for another) becoming less worried about the opinions of others, and more authentic and autonomous.
Adjustment Therapy involves horizontal translation – we move from one position to a better one at the same level. Liberation Therapy may involve vertical transformation, where our whole idea of who we are and what we are about may change quite radically.
Looked at in this light, the old argument about short-term versus long-term therapy looks quite different. Short-term work is often very much indicated for Adjustment Therapy: it is seldom much use for Liberation Therapy. Conversely, Liberation Therapy normally entails long-term therapy, though sometimes it the person is ripe and ready enough, short-term work is sufficient.
It can happen, of course, that someone comes for Adjustment Therapy, but it then turns out that the problems are much older, much more deep-seated than was apparent at first. It will then become long-term work, but will not necessarily turn into Liberation Therapy. A person who is damaged deeply and early may require long-term work, not because they have moved over into personal growth, but because there is so much work to be done at a deep level if anything at all is going to change. And a person who thinks they are coming for a long-term stint may find everything resolved in short order, simply because they are so ready to move on – ripeness is all.
The Psychoanalytic Approach
The humanistic view has traditionally been that psychoanalysis aims at adjustment to the status quo, while the various humanistic approaches aim at liberation, including spontaneity, creativity, authenticity and the real self. But a book came out not long ago written by two psychoanalysts saying that this was not the case. They pointed to a split within psychoanalysis itself. They pointed to the fact that we find some people, such as Karen Horney, Bernard Robbins, Maxwell Gitelson, Ernst Ticho, B. Glueck and Donald Winnicott, were found to be saying that the ultimate aim is autonomy, liberation and the discovery of the true self.
The authors also had to say, of course that we find others, such as Waelder, Gaskill, Rangell, Brenner and Kernberg, saying that the ultimate aim is to understand the pathological structures, and to work through their connections within the patient, thus ending the psychopathology. This is about coming to terms with the real limitations of life: it would include the ability to increase the patient’s capacity to tolerate temporary regression and to recover from it. “More adaptive kinds of compromise formations are instituted.” In other words, adjustment. (Sandler & Dreher 1996).
What I noticed about this book, however, was that no matter how I chased through the extensive quotations given in it. I could not find the words “authenticity” or ”spontaneity” anywhere in this book. It still seems to me, then, that there is a difference between the psychoanalytic approach and the humanistic one, even when we look at those psychoanalysts who are closest to the humanistic position .
The Cognitive-Behavioural Approach
It hardly needs to be argued that the cognitive-behavioural approach is all about adjustment. We find statements such as – “These studies showed cognitive therapy to be as effective as anti-depressants with depressed patients”, “Beck suggests that we are all capable of functioning as rational problem-solvers”, or more elaborately: “Cognitive therapy has three main goals: to relieve symptoms and to resolve p roblems: to help the client to acquire coping strategies: to help the client to modify underlying cognitive structures in order to prevent relapse.”
All these quotes come from the chapter by Moorey (1990).
In behaviour therapy, again, we have clear statements such as: “The behavioura l model views psychological well-being in terms of control over one’s environment and good adjustment in social, interpersonal, work, sexual and leisure activities . (O’Sullivan 1990)
It would not be profitable to go further into this, since it is well known that the cognitive-behavioural approach always prefers to have definite goals agreed with the client.
It is hard to be sure about the Jungians, since they are wildly different in their ideas and practices. Jung himself was clear enough. He says:
“As far as possible I let pure experience decide the therapeutic aims. This perhaps seem strange, because it is commonly supposed that the therapist has an aim. But in psychotherapy it seems to me positively advisable for the doctor not to have too fixed an aim.” (Jung 1966) This makes it clear that Jung was basically more interested in Liberation Therapy. James Hillman, it seems to me, goes further. He says:
“Suffering is necessary for increased awareness and the development of personality… If malfunctioning and suffering are viewed only pathologically, the physician prevents himself from sensing his own wound… The purpose of train ing analysis is not merely to heal the personality of the analyst, but to open his wounds from which his compassion will flow.” (Hillman 1990)
This striking statement goes deeper, and says that far from therapy being about cu re or adjustment, it is about respecting pain and death. Hillman goes on to talk about how the therapist should treat complexes or subpersonalities:
“As energetic centres, complexes rather than cured or killed may be transformed, and as purposeful entelechies the dialectic with them develops their dynamism and furthers consciousness.” (Hillman 1990) This again is an original statement, which it seems to me goes further than most in showing respect for what the client brings. Of course, one of the definitions of what Jungians are ultimately after is individuation. Andrew Samuels has an excellent chapter entitled ‘The Self and Individuation’ which deals with this. He says:
“When discussing individuation, it is important to remember that Jung was careful to distinguish this from an ‘unconscious wholeness’, a false individuation. ’Conscious wholeness’ in contrast is a successful union of ego and self so that both preserve their intrinsic qualities.” (Samuels 1985)
In the discussion of individuation, it seems clear that this is one of the most important general aims in Jungian analysis. And Colin Feltham and Windy Dryden go so far as to say that: “Individuation can be roughly equated with self- actualization.” (Feltham & Dryden 1993) It seems, then, that the Jungian approach is about liberation.
The Humanistic Approach
And this brings us to the humanistic approach. Considering the wide variety of schools which come under the humanistic umbrella, there is an impressive degree of unanimity about the goals of this general approach.
In Gestalt therapy, it is well known that Fritz Perls used to say that most people went in for the actualisation of their self-image, whereas he was more interested in the actualization of the self. In recent Gestalt therapy there have been many changes since the sixties, but we still find a basic text saying: “Self-actualization, then, is an organismic process involving the gradual development of one’s unique potential through the acknowledgement of what one is.” (Korb, Dorrell & Van de Riet 1989) And the authors go on to say that one of the most important aspects of the self-actualised person is authenticity. As we shall see, authenticity is one of the key aspects of humanistic goals. The same authors continue: “The person who is free of unfinished business from the past, free of unrealistic expectations of the future, in touch with present organismic processes, and in good contact with the environment will express the self authentically.” In their biography of Fritz Perls, Petruska Clarkson and Jennifer Mackewn have this to say: “The fullness of living is born not of inauthentic manipulation and control of other people and the environment, but of authentic self-realization. People actualize their full potential by knowing and facing themselves in their wholeness.” (Clarkson & Mackewn 1993)
Similarly, James Bugental (one of the premier writers on authenticity in our time) says that authenticity is a combination of self-respect (we are not just part of an undifferentiated world) and self-enactment – we express our care or involvement in the world in a visible way. Here is a key quotation: “By authenticity I mean a central genuineness and awareness of being. Authenticity is that presence of an individual in his living in which he is fully aware in the present moment, in the present situation. Authenticity is difficult to convey in words, but experientially it is readily perceived in ourselves or in others.” (Bugental 1981) In other words, what we in humanistic psychology are saying is that authenticity is an experience. And it is an experience which we seek in therapy – both for the therapist and for the client. And this is not an easy option. As Jean-Paul Sartre memorably put it: ”Authenticity consists in having a true and lucid consciousness of the situation, in assuming the responsibilities and risks that it involves, in accepting it in pride or humiliation, sometimes in horror and hate. There is no doubt that authenticity demands much courage and more than courage. Thus it is not surprising that one finds it so rarely.” (Sartre 1948) This is still as true today as it was when it was first written. Authenticity and self-actualization is no easy option. It may be noticed here that any version of psychotherapy which says that everything that happens in the session must be either transference or countertransference can have no place for authenticity.
One of the most fully worked-out theoretical statements on the values of actualization and integration for the humanistic approach is to be found in the work of Alvin Mahrer. His theory of the optimal state is to be found in two chapters, one on integration (78 pages) and one on actualization (42 pages). It would be out of place to try to do justice to all this here, but let us just quote a couple of passages to get the flavour: “It involves the commitment to be whatever there is within to be. This is the leap of faith, the tearing of one’s self from what one is and the falling into whatever is there within. In this commitment, I am the one to decide the one who makes or fails to make the commitment. It is my commitment not my parents’ or my group’s or my spouse’s. I am the responsible director of my process of internal change.” (Mahrer 1989)
That was from the chapter on integration. And here is one from the chapter on actualization: “The highest levels of interpersonal relationships are thos e characterized by integration and actualization. This kind of relationship exceeds one of integrative love, mutual integrative oneness, and mutual integrative being- one-with. Because of the nature of actualization, these highest levels of interpersonal relationships are also characterised by mutual contexts enabling each participant toward increasing depth and breadth of experiencing. When relationships are of this order they define the highest and most valued interpersonal relations available to human beings.” (Mahrer 1989)
It can be seen that integration and actualization do not result in a separate autonomous self which has no need for others. This is sometimes not quite understood by those who think that humanistic psychology is defined by Maslow and Rogers.
This has been a brief trot round some important landmarks. I suppose what I really wanted to say was that if we make a clear distinction between adjustment therapy and liberation therapy we are in a better position to resist any doctrine or argument which depends upon the assumption that there is just one thing called therapy.
Some people may feel that I should have said something about transpersonal therapy. My view on this is that transpersonal work in psychotherapy should not be regarded as a separate form or school of therapy, but as a dimension which we ignore at our peril. It is clear to me that transpersonal work is within the framework of liberation, and simply takes it further into higher or deeper realms.[John Rowan is a psychotherapist and author of many books on Humanistic Psychotherapy, including The Reality Game 1983 and Ordinary Ecstasy 1988.]
Bugental, James F T (1981) The Search for Authenticity (Enlarged Edition) New York: Irvington.
Clarkson, Petruska & Mackewn, Jennifer (1993) Fritz Perls London. Sage
Feltham, Colin & Dryden, Windy (1993) Dictionary of Counselling London: Whurr
Hillman, James (1990: 1964) Suicide and the Soul Dallas: Spring
Jung, Carl Gustav (1966) The Practice of Psychotherapy (Collected works vol.16) London: Routledge
Korb, Margaret P, Gorrell, Jeffrey & Van de Riet, Vernon (1989) Gestalt Therapy: Practice and Theory (2nd ed) New York: Pergamon Press
Mahrer, Alvin R (1989) Experiencing Ottawa: University of Ottawa Press
Moorey, Stirling (1990) ‘Cognitive Therapy’ in W Dryden (ed) Individual Therapy: A Handbook Buckingham: Open University Press
O’Sullivan, Geraldine (1990) ‘Behaviour Therapy’ in W Dryden (ed) Individual Therapy: A Handbook Buckingham: Open University Press
Samuels, Andrew (1985) Jung and the Post-Jungians London: Routledge
Sandler, Joseph & Dreher, Anna Ursula (1996) What do Psychoanalysts Want? The Problem of Aims in Psychoanalytic Therapy London: Routledge
Sartre, Jean-Paul (1948) Existentialism and Humanism London: Methuen